Why is it important to monitor proper hydration in babies?
A child is not a miniature adult: this is a basic concept in medicine that should not be overlooked. Indeed, a baby is still physiologically immature: its specific needs must therefore be taken into account.
Hydration is an aspect on which babies are very different from adults; in this article we will explain why and, above all, how to ensure children are properly hydrated to guarantee their health, and the available oral rehydration solutions (ORS).
The baby: an organism that is still immature
A newborn baby is comparable to a sponge: composed of 70 to 75% water, it is therefore highly hydrated, but it also dehydrates very quickly.
This rapid dehydration is due to the fact that the skin is still an immature organ in babies, and is therefore more permeable than an adult's skin for several reasons:
At birth, the skin is smooth and without wrinkles, and thin. Over the years, layers of cells will be added to thicken and protect it.
During the first years of life, the skin is bare; it is only from the age of 2-3 years that a hydro-protective film will be established, making the skin a little more waterproof.
Because an infant's skin surface area to weight ratio is very high, any loss of water will have more pronounced consequences in these individuals than in adults.
It is therefore essential to closely monitor a child's hydration : dehydration can occur very quickly and have serious consequences!
The main causes of infant dehydration and the effects of diarrhea:
The two most frequent situations leading to severe dehydration in infants are the following:
• Heat : In summer during periods of high heat, a child sweats much more than an adult and loses a very large proportion of water relative to their weight.
• Various pathologies : acute diarrhea in infants, episodes of gastroenteritis, vomiting.
These conditions result in very rapid water loss in the infant, and if rehydration is not done quickly, the emergency can become life-threatening and the child can quickly end up in a pediatric emergency department.
Rehydration is rapid in children under 2 years old and can be fatal within hours; therefore, it is crucial to recognize the signs of dehydration in order to act quickly. In cases of diarrhea , oral rehydration solution in sachet form is the most commonly used solution. It contains sugar, sodium, and potassium to replace lost electrolytes and facilitate fluid absorption thanks to its isotonic formula.
Signs of dehydration in infants
Here are some tips to spot dehydration in infants; many are physiological signs also found in dehydrated adults (for more information on the subject, you can consult our article: what are the effects of dehydration ?).
The easiest sign to spot is urine production :
Healthy babies produce a wet diaper every few hours.
A dehydrated baby will have a reduced urine output and will only produce a wet diaper every 4 to 6 hours. The urine will also have a stronger odor or a darker color than usual, due to the fact that it is less diluted because there is less water in the body.
Significant weight loss can be due to dehydration :
· In cases of mild to moderate dehydration, the child's weight loss will be between 3 and 9% of body weight.
A weight loss of more than 9% of body weight will be a sign of severe dehydration.
The appearance of the fontanelles :
They are generally aligned with the rest of the scalp.
· In a slightly to moderately dehydrated infant, slightly sunken or depressed fontanelles will be observed.
• Deeply sunken fontanelles indicate severe dehydration. (Notable pulsations at the fontanelles may also be visible in this case.)
A change in a baby's behavior can also be due to dehydration:
· In the case of mild to moderate dehydration, a child may be found to be lethargic, apathetic, and more irritable than usual.
Severe dehydration can lead to extreme drowsiness (difficulty waking the baby) but it can even progress to loss of consciousness and coma!
Other physiological signs are linked to dehydration:
· The extremities (hands, feet) are cold;
· Very few tears are produced when the baby cries;
· Her mucous membranes are dry and sticky;
· The skin may appear spotted, mottled;
· One may experience an increase in heart rate (tachycardia) with a slowing of the pulse (because there is less blood volume to pump, so the heart beats faster to pump what remains throughout the body).
The skin fold test on a child can provide clues about their hydration level :
· In a hydrated infant, after gently pinching the skin it immediately returns to normal.
• In a dehydrated infant:
o In the case of mild to moderate dehydration: the skin may take up to 2 seconds to return to normal.
o In the case of severe dehydration: the skin takes more than 2 seconds to normalize or may remain wrinkled.
How to hydrate a young child
Normally breast milk or infant formula is sufficient to keep the child hydrated, but how can we compensate for water loss if we observe a lack of hydration despite this?
If the mother is breastfeeding: she must increase her own water intake so that there is more water in her milk.
In other cases: when the child is fed with infant formula, first stage milk: if the child does not finish the bottle, a little water can be offered, but the problem is that infants very often do not like water.
Here are a few tips to remedy this :
• Before 4 months: Try to get them to drink water regularly, in small amounts. Put it in the fridge beforehand to make it cooler: the baby will accept it better because the cold soothes sore gums.
Be careful not to give water that is too cold, as this could cause diarrhea!
• You can possibly give suitable herbal teas based on fennel or chamomile.
· In extreme cases, one can try giving the water with a syringe.
All sugary drinks should be avoided before 5-6 months: especially fruit juices.
From 5-6 months onwards, you can start giving pressed fruit juices, but not nectars which are too sweet.
· It is still possible, if the child does not accept water, to put a few drops of juice in the bottle.
What about ORS (oral rehydration solution) in cases of infant diarrhea?
This is something you should always have at home: these are preparations rich in bicarbonates, carbohydrates, mineral salts that allow you to quickly rehydrate the child in extreme cases.
It is to be used in case of vomiting or diarrhea: during the first few hours, according to the pediatrician's instructions, it will be the only thing to give the child because it is the only solution that the child will not vomit (if you give water alone, the child will vomit it).
It comes as a powder solution to be poured into the baby bottle of water; once mixed, the mixture is colorless.
These rehydration solutions are the equivalent of our Hydratis® tablets, which work on the same principle for adult hydration. We advise breastfeeding mothers to use Hydratis® tablets to promote hydration after consulting a healthcare professional (doctor or pharmacist).
When it comes to children's hydration, skin hydration should not be neglected: after bathing, apply body lotions suitable for children. Be careful not to give baths that are too hot or too long, as this could dehydrate the child.
